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UNIT 3 - The First 1000 Days of Life
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The First 100 Days of Life
​
The Mind, Brain, and Body
Developmental Plasticity, Health and Disease
​The Role of Microbiome
Maternal and Child Nutrition

Article review
Video review

OBJECTIVES:
  • Discuss the factors contributing to the major health issues rooted in the early years of life.
  • Identify connection of emotional experience in early neurological development.
  • Understand the foundations of developmental plasticity and the future disease risk.
  • Describe the role of microbiome in the first 100 days of life

The First 1000 Days of Life

Many challenges in adult society have their roots in the early years of life, including major public health problems such as obesity, heart disease, and mental health problems. Experiences in early childhood are also related to criminality, problems in literacy and numeracy, and economic participation. It is important to learn about the biological processes and environmental characteristics that shape development during the first 1000 days, and what impact these have over the life span.

Although the notion of critical / sensitive periods in development has been around for many years, the full extent of early developmental plasticity has not become evident until recently. Moreover, the general public’s perception of how young children develop and learn is often based on the perception that children are passive absorbers of knowledge who do not show signs of genuine learning until they are older. The recent interest in the early years has been prompted by growing awareness that what happens during this period of development has lifelong consequences for children’s health and wellbeing . It has also been prompted by a growing understanding of how early disparities in children’s functioning can develop and the problems that this can create for future education, employment and opportunities.

The Mind, Brain, and Body

In seeking to understand early development, there has been a tendency to focus on neurological development at the expense of other aspects of development. Thus, efforts to disseminate new research knowledge have used the metaphor of ‘brain architecture’ to convey the sense of the importance of early neurological development, and discussed how positive early experiences build neuronal connections and adverse experiences disrupt them. This way of framing early development reflects an underlying belief in the importance of the brain as the seat of personhood and learning. However, as shown in studies, ‘framing brain development in terms of building neuronal connections and brain architecture fails to capture the fact that brain functioning is not purely cognitive, that ‘learning’ is not purely conscious, that the brain is not purely skull-based, and that the brain is closely linked with other key bodily systems.

​First, the brain is not purely cognitive, but is also profoundly emotional. Thus, our emotions directly influence the functions of the entire brain and body, from physiological regulation to abstract reasoning. In fact, emotion serves as a central organizing process within the brain, and our ability to organize our emotions directly shapes the ability of the mind to integrate experience and adapt to future stress. Second, learning is not a purely conscious process. Much of our most important emotional and interpersonal learning during the first few years occurs before we have developed the neurological capacities for conscious awareness and memory. Thus, many of the most important aspects of our lives are controlled by reflexes, behaviors, and emotions learned and organized outside our awareness. Third, the brain is not just skull-based, but ‘embodied’, being shaped by messages from all over the body via the central and peripheral nervous systems. 1 This embodied brain shapes and is shaped by both its external and internal environments. Finally, the brain is not a stand-alone bodily system, but is intricately connected to other major bodily systems, including the immune, endocrinal, metabolic, gastrointestinal, cardiovascular, enteric and musculoskeletal systems. These systems shape and are shaped by each other, and function as an integrated mind-brain-body system. This means that what is ‘learned’ in the prenatal and first two to three years of life affects not only the neurological system but also the other bodily systems to which the brain is connected, with potentially profound consequences over the life course. ​

Developmental Plasticity, Health and Disease

​​One of the most significant features of human biology is our capacity to adapt to different social and physical environments. This capacity is known as developmental plasticity. While we retain some capacity to adapt throughout our lives, developmental plasticity is at its greatest in the first 1000 days or so of life, and it plays an important role in development from the moment of conception. Adapting to the immediate environment is the major developmental goal or activity during the first 1000 days and this developmental focus makes the influence of the environment particularly critical over this time. During development, there are brief critical periods during which a system or organ has to mature. These occur at different times for different systems, and they occur in utero for most systems. After birth, only the brain, liver and immune system remain plastic. Thus, much of human biological development is completed during the first 1000 days. In the brain or central nervous system, it is more accurate to talk about sensitive periods, time windows during which the effect of experiences on brain development is unusually profound and can strongly shape the neural circuits. This is another instance of developmental plasticity, known as neuroplasticity, and refers to the biological capacity of the central nervous system to change structurally and functionally in response to experience, and adapt to the environment. Neuroplasticity is greatest during pre- and postnatal brain development: the young brain has a repertoire of neuroplasticity responses that are not evident in adults, and which allow the young brain to develop appropriately and adapt constantly to environmental experiences and exposures. This capacity to adapt makes the human species both versatile and vulnerable at the same time: the changes made might be adaptive for the immediate environment, but they can come with long-term costs, both psychologically and physically. For instance, in the early development of the brain, neuroplasticity can lead to significant maladaptive outcomes depending on factors such as the nature and extent of adverse exposures, and the stage of neurodevelopment during which they occur. Patterns of abnormal neuroplasticity have been identified as core features of many pediatric disorders of the central nervous system, including cerebral palsy, intellectual disabilities, autism spectrum disorders, and neuropsychiatric disorders such as attention deficit hyperactivity disorder.

During the months before our birth, most of our major structures and body functions are put in place. Small or subtle happenings in this period can have slow ripple effects that may not be revealed for many years. Key organs, such as the brain, the heart, the kidneys and the lungs are all formed in this period. In many cases the full quota of cells in these organs is fixed at birth (in the heart and kidney) or soon after (the brain and lungs). Even unnoticed, early adverse events might reduce the quota of heart-muscle cells, or the number of functional kidney units (nephrons), or the lung capacity that we are born with. And much of that is set for life. Once these organs are formed, we can’t grow new heart muscle or nephrons, although stem-cell research is trying hard to overcome these biological limitations. 

​Protection for the fetus is provided by two protective barriers, the blood–brain barrier in the fetus itself and the placental barrier. Both barriers develop during early pregnancy and act as filters to regulate the flow of specific nutrients and substances. The blood-brain barrier acts as a barrier to protect the development and function of neurons. These develop early: in the developing human brain, the growth of neurons begins in the embryonic period at about 6 weeks’ gestation, peaks at 14 weeks, and is largely complete by 25 weeks. Meanwhile, the placenta acts as a selective filter for potentially harmful substances circulating in the maternal blood. Until relatively recently, it was thought that the fetus was completely protected from the mother’s physical and emotional environment by these twin barrier. However, we now know that, while the placenta provides some protection against infection and maternal cortisol, there is free exchange between the embryonic and maternal blood systems, and the placental wall (which is thinnest in the first trimester when the fetus is developing most rapidly) does not protect the fetus against drugs, alcohol, smoking, environmental toxins or severe maternal stress. 

The Role of Microbiome

Vast numbers of bacteria, viruses, and fungi (collectively known as the microbiome) live in and on the human body and play an important role in maintaining our health and wellbeing. Microbes outnumber our human cells and therefore the genes that are transmitted from parents to infant are predominantly microbial9. It has been estimated that only 1 per cent of genetic transfer is human, with the genes of microbes – the ‘second human genome’ – making up the rest. Thus, rather than being a single stand-alone species, humans are more properly understood to be superorganisms made up of thousands of biologically diverse species. The microbiome contributes significantly to individual differences between us: while humans are relatively homogeneous in their genetic makeup, we vary greatly in the composition of microbiomes, with only a third of the microbiome’s constituent genes found in a majority of healthy individuals.

The diverse ecology of microbes that make up the microbiome has coevolved with our species over millennia. These microbes provide us with essential services in exchange for being housed and fed. In particular, it is the bacteria in our gut that play a critical role in our physical and even our mental health. The beneficial functions they perform include helping digest food components that our guts cannot process (including essential elements in breastmilk), regulating our bodies’ metabolisms, producing hormones, detoxifying dangerous chemicals we ingest with our food, training and regulating the immune system, and preventing the invasion and growth of dangerous pathogens. By virtue of its ability to confer an extensive set of protective and functional benefits to its human host, the gut microbiome can be considered a microbial or metabolic ‘organ’, and maintaining the proper health and functionality of this ‘organ’ is of significant importance. In short, it is the microbiome that helps keep us healthy. The brain, the gut, and the microbiome are in constant close communication, and function as parts of a single integrated system – the brain-gut-microbiome axis.

The first 1000 days are particularly crucial in shaping the architecture of this axis: both the brain and the microbiome are still developing, and changes during this period tend to persist for life. The consequences may not emerge until later in life, when the diversity and resilience of the gut microbiome decreases, making us vulnerable to degenerative diseases such as Alzheimer’s or Parkinson’s disease. Any change in the abundance, or composition or diversity of these micro-organisms can have significant health consequences. For instance, it may lead to failures to regulate and restore appropriate immune and inflammatory responses which can contribute to chronic inflammatory conditions such as inflammatory bowel disease and asthma, and may even play a role in the development of conditions such as autism spectrum disorder, psychiatric disorders such as depression, and neurodegenerative conditions such as Parkinson’s disease. Since the traffic on the brain-gut-microbiome axis is two-way, our mental states can shape the composition of our gut bacteria.

​For instance, one study found that the infants of mothers who experience cumulative stress during pregnancy show marked disturbances in the composition of their gut bacteria, and subsequently have more health problems, such as infant gastrointestinal symptoms and allergic reactions. Disturbances of the composition of the microbiome – known as dysbiosis – can take several forms: a loss of beneficial microbes, an expansion of harmful microbes, or a loss of overall microbial diversity. It was suggested that the conditions promoting dysbiosis are unequally distributed across society, with those living in socioeconomically deprived conditions where grey space (as opposed to green space) is the dominant environmental feature being more likely to be experiencing dysbiosis.
The two sources of microbial exposure that are important for human health and development – environmental and human microbiota – have both become less diverse as a result of modern lifestyle changes. In addition, environmental changes such as urbanization, higher exposure to chemicals and less exposure to green spaces, have reduced our exposure to a diverse range of plant, animal and microbial life. This has been linked with a range of mismatch diseases, including allergies, and Type 1 diabetes and asthma. Our developmental health is also at risk because parts of our ancestral microbiome are disappearing. This is due to a range or factors, including overuse of antibiotics (in treating humans and in promoting the growth of the animals we eat), overuse of caesarean section births when not strictly necessary, the widespread use of sanitizers and antiseptics, and the shift to a Westernized high-fat high-carbohydrate high-fructose diet.

Studies show that it is easier to reduce gut microbial diversity in adults than it is to increase it above the level established in the first 1000 days. Although the womb was thought to provide a sterile environment for the fetus, we now know that some bacteria are able to cross the placenta, although we know very little about the nature and impact of microbes that do so. What we do know is that, from birth onwards, infants are rapidly colonized by a remarkably wide diversity of bacteria. In the case of the colonization of the gut, the composition of gut microbiota in infants is markedly different from those in adults, but becomes progressively more adult-like as the infant acquires more microbes from the people around them, and reaches an adult-like form by the age of three. Thus, the transition from no microbiota to an adult-like microbiome is all accomplished during the first 1000 days or so of life. Just as the human epigenome is developmentally programmed by the early environment, so too is the human microbiome. In the postnatal period, microbial colonization is influenced by factors such as gestational age, antibiotic exposure, delivery mode, breastfeeding, formula milks, timing and types of solid foods, and genetic factors.

​The importance of acquiring a full complement of microbiota in the early years is captured in the self-completion hypothesis – which maintains that the single, most pivotal sign in distinguishing a life course of health versus that filled with disease is a successful and timely ‘seeding’ with an optimal complement of microbiota. There appears to be a narrow developmental window for effective seeding surrounding birth, and the completion of the full microbiome over the next two and a half to three years shapes their gut microbiome for a lifetime. The immune dysregulation created by missing gut microbes during key periods of immune maturation can remain into adulthood and act as a biomarker of specific health risks. The microbiome evidence is another form of mismatch. The developing immune system appears to be particularly susceptible to modern environmental change, with the most common and earliest developing non-communicable diseases being immune-related conditions such as allergies and obesity.  
​Nutrition and lifestyle before and during pregnancy, lactation, infancy and early childhood have been shown to induce long-term effects on later health of the child, including the risk of common non-communicable diseases such as obesity, diabetes and cardiovascular disease. This phenomenon is referred to as “Early metabolic programming of long-term health and disease” or “Developmental origins of adult health and disease”.

To strengthen the evidence base, researchers from 36 institutions across the European Union, the United States, and Australia collaborate in the European Commission funded 
“EarlyNutrition Research Project” (http://www.project-earlynutrition.eu). This international multidisciplinary research collaboration explores how nutrition and metabolism during sensitive time periods of early developmental plasticity can have an impact on cytogenesis, organogenesis, metabolic and endocrine responses as well as epigenetic modification of gene expression, thereby modulating later health. Because of the global escalation in the prevalence of obesity, particular focus has been placed on the developmental origins of adiposity (i.e., body fatness), leading to increasing evidence that early life programming could contribute to the intergenerational transmission of obesity and associated health outcomes.​

Maternal and Child Nutrition

The first 1000 days range from conception to the end of the child’s second year of life. The first 1000 days of life are characterized by rapid growth and development, maturation of all organ systems, and establishment of metabolic patterns. Also, in this period the fastest rate of neurodevelopment of cognitive functions occurs. It is important to focus on healthy nutrition and development during the first 1000 days which will have benefits throughout life. Nutrition quality and quantity during the first 1000 days affect the risk of developing chronic and metabolic diseases. Children should maintain an adequate nutrition through proper maternal diet, exclusive breastfeeding for the first 6 months, starting adequate complementary foods after 6 months, and continued breastfeeding for up to age 2. The first 1000 days is a critical period of developmental plasticity: the capacity to express specific adaptive responses to environmental experiences.

It has been shown that during this sensitive period organisms are affected by nutritional, hormonal, and metabolic environmental experiences, and that these experiences lead to lifelong consequences for health and wellbeing. Early-life nutritional experiences can permanently program the cells’ and organs’ structures, functions, and metabolism. Inappropriate metabolic and endocrine responses occur in organs like the brain, adipose tissue, muscle, liver, and pancreas. Structural and functional changes in the cells and organs due to changes in metabolic, neuroendocrine and immunologic responses, gene expression, and epigenetic mechanisms can cause fetal metabolic programming. These factors affect growth, development and cognition, and the risk of cardiovascular diseases, metabolic disorders, allergies, and obesity. Both low and high birth weights may lead to physiological and/or metabolic adaptations in vital organs, and may result in disruptions in normal growth and development.

Low birth weight is known to have important effects on a child’s growth, development, and health status later in life. Stunting, greater susceptibility to infections, lower cognitive performance, and increased risk of adiposity, cardiovascular disease, diabetes mellitus, hypertension, and all-cause mortality happen more in low birth weight children in the long term. Higher birth weight has been shown to be associated with higher obesity, diabetes, and cancer risk in adult life. Therefore, prevention of both low and high birth weights through nutrition and health intervention is important during pregnancy. It is known that maternal metabolism of obese women is altered in pregnancy, and off spring of obese mothers has a higher percentage of body fat.

​Maternal lifestyle, diet, body weight, and metabolism affect the utero metabolic environment which influences fetal body composition, metabolism and gene expression. It is important to ensure a healthy and balanced diet during pregnancy to maintain the child’s health throughout life. Also, both overweight and obese women that are planning to become pregnant have to lose their excess weight before pregnancy. Another important issue in the first 1000 days that is related to nutrition is breastfeeding. Exclusive breastfeeding is recommended for the first 6 month of life, and then continued breastfeeding along with appropriate complementary foods for up to age 2. Human milk contains bioactive molecules like cells, immune factors, hormone anti-infectious and anti-inflammatory agents, growth factors, and prebiotics that protect the infant against infection and inflammation, and contribute to immune maturation, organ development, and healthy microbial colonization.
​Furthermore, breast-fed infants accept new vegetables more easily, and have higher acceptance of new foods when they are introduced during complementary feeding. Complementary feeding practices are important to prevent obesity later in life. Six months of age is the optimal time to begin adequate complementary feeding. Early repeated exposure to a wide variety of healthy foods and repeated exposure to the same food for up to eight times may facilitate the acceptance of new foods; especially vegetables. Infants that maintain daily variety in their diet accept new flavors more easily than infants that follow a monotonous diet. This underlines the importance of introducing a variety of foods in early childhood. Repeated early exposure to different foods could affect children’s food preferences later in life.

​There is a growing body of evidence which suggests that experiences during the first 1000 days of life can have long-term consequences for the child’s health. Over nutrition in infancy and childhood, like consumption of diets that are high in energy, protein, sugar, sodium, and saturated fats also has long-term consequences, leading to inappropriate metabolic responses, changes in body composition, and increases the risk of becoming overweight, becoming obese and having chronic diseases in later life. Adequate development and nutrition during the first 1000 days contribute to decrease in mortality and morbidity in children, increase in cognitive and motor development, increase in social performance and learning capacity, increase in adult height, and decrease in obesity and metabolic diseases. As a conclusion, it is well recognized that the adequate nutrition for the mother and the child during this time can have a profound impact on the child's growth and development, and reduce disease risk.

Article Review

Nutrition in the first 1000 days
Nutrition in the First 1000 Days: Ten Practices to Minimize Obesity Emerging from Published Science

Video Review


Unit Task

  1. Conduct an interview and assessment with at least two pregnant women. Evaluate and document their lifestyle practices using the forms you've been using from the previous tasks.​ Discuss about the First 1000 days of Life.  Create a written summary of your activity and include the personal reflection (verbatim) of your clients.
  2. Submit your Reflective Journal after watching the videos, reading the lesson and article.
SUBMIT COMPLETED TASK HERE

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